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The United States spends nearly 20% of its GDP on healthcare, more than twice as much as typical other first world economies. Scary! Blame the Big Mac if you like, but much of the solution is tied to land use and how the way we live and get around impacts our health. Healthy communities was all the rage at the ULI Fall Meeting, with the release of, what else(!?), 10 Principles for Building Healthy Places and several panel discussions surrounding the ULI Building Healthy Places Initiative. One such panel included developers and foundation presidents from around the country.

Perhaps the most robust piece of the ULI initiative is occurring in partnership with ULI Colorado. The At Healthy Places: Designing an Active Colorado is occurring with generous support from the Colorado Health Foundation. A $4.5 million grant will provide guidance in the coming years to help three Colorado communities design for healthier living. Anne Warhover of the Colorado Health Foundation pulls no punches when she questioned why we should give children a healthy choice for lunch? “Why should kids have a choice? They’re kids.” In other words, there shouldn’t even be an unhealthy choice. Hopefully candor like Warhover’s will lead to meaningful results like road diets and mixed-use development that improve health for Coloradans. Should wide, unsafe, unwalkable roads and single-use zoning even be a choice? I’ll address this later.

Developers are providing healthy solutions. In addition to an edible garden in one of its parking lots, The Cornerstone Group in Minneapolis has a garden on the rooftop of one of its apartment projects that provides produce to a local restaurant. And thanks to Colleen Carey, President of The Cornerstone Group, for patiently explaining how Minnesotans embrace a “culture of health.” We don’t shut down, but rather how we embrace being active and outdoors evolves by season. On multiple occasions at this ULI Fall Meeting I sensed a profound misunderstanding about what life is like in Minnesota. Indeed, R.T. Rybak, outgoing Minneapolis mayor and ULI Rose Fellowship leader, helped create the City of Lakes Loppet, where we put snow on our streets and have a cross-country ski race through Uptown. It is magnificent, and I dare say an example of how Minnesotans embrace the seasons perhaps better than anywhere else. It does keep us healthier.

Elsewhere, Willowsford, a master planned community outside of Washington D.C., has a focus on walkability and a farm at its core. I’ve often wondered why CSAs and farm-to-table restaurants are more popular in the urban core, whereas the suburban fringe seems to have less of a relationship with agriculture despite being right next to it. Laura Cole of Corbelis, the developer, commented “how removed we are from food.” Willowsford seems to buck that trend, embracing its farm and the healthy living it helps to provide. Cole also noted that front porches help encourage better interaction among neighbors, reminding us that sometimes the answer to healthier communities is so simple.

An intriguing nugget of an idea from an earlier panel on healthy communities suggested a program like location efficient mortgages be implemented and tied to health. In other words, whereas a bank recognizes the savings for a household living near transit and is willing to provide a larger mortgage as a result, what if healthcare providers could give a discount for where clients live their lives, just like they give a discount for visiting the health club? It seems like it’s only a matter of time they reward healthy living.

At the panel where the concept of “healthy mortgages” was suggested, Peter Calthorpe reminded the audience that this issue is profoundly partisan. No serious solution will be brought forward without one brought forward without being trashed by one side or the other. What can’t be lost in this debate is the way we make land use and transportation decisions today is unhealthy, and there is no choice. In most places, zoning inhibits a meaningful mix of uses, and worse, traffic engineering standards make roads overly wide and fast, forcing us to drive. We must cast healthy communities as a choice, a free-market alternative to the profoundly unhealthy lack of choice we are given today. Doing so may be the only way to achieve healthier communities in the United States.